114 A case of progressive wall thinning of apical myocardium in 5 year- old boy with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is defined by the presence of increased left ventricular (LV) wall thickness that is not explained by abnormal loading conditions without a priori assumptions about etiology or myocardial pathology even in neonate, children and adults. The diagnosis of HCM is mainly the detection of increased LV wall thickness by any imaging modality. Due to its diverse etiology, the disease phenotype includes chest pain, palpitation, syncope and heart failure. In most patients, there is a life-long process of progressive and adverse cardiac remodeling, characterized by myocardial fibrosis and wall thinning. However, there was no report about cardiac remodeling of progressive wall thinning in children with HCMP.

A 5 year-old boy was evaluated due to familiar HCMP, and finally confirmed with HCMP by echocardiography. His father was diagnosed as asymmetric HCMP and treated with septal alcohol ablation 3 years ago. His family referred for genetic counselling. His symptom was vague because he was very young. Initial electrocardiographic finding was normal sinus rhythm with left ventricular hypertrophy. Ambulatory electrocardiography (ECG) showed isolated premature ventricular contraction. Initial echocardiographic findings revealed asymmetric septal hypertrophy with diffuse hypertrophied LV myocardium, systolic anterior motion of anterior leaflet of mitral valve without LV outflow tract obstruction (LVOTO) and only mild dynamic obstruction on mid-septum of LV. His cardiovascular magnetic resonance imaging (CMR) showed similar to echocardiographic findings and no late gadolinium enhancement (LGE). He started to take medication with beta blocker, and later addon verapamil. After 3 years later, his ambulatory ECG showed non-sustained ventricular tachycardia of 4 episodes. Follow-up echocardiographic findings revealed progressive septal wall thickness from 13mm to 19 mm, marked LVOTO with peak pressure gradient of 128 mmHg and profound dynamic obstruction on mid-septum of LV. Follow-up CMR imaging showed additional progressive apical wall thinning without suspicious or definite LGE on any other myocardium. Urgently he undertook the implantation of implantable cardioverter defibrillatorsfor prevention of sudden cardiac death. Now he is listing and waiting for heart transplantation. Cardiac remodeling is progressively life-long process in most HCMP, but in this case with pediatric HCMP, even though he took medical treatment its progression was rapid cardiac remodeling.

Location and pattern of non-invasive keratographic tear film break-up according to dry eye disease subtypes

PURPOSE

To compare the non-invasive keratographic tear film break-up time (NIKBUT) and the location and pattern of non-invasive keratographic tear film break-up between normal group and each group of three dry eye disease (DED) subtypes.

METHODS

We enrolled 55 normal subjects and 250 patients with DED, who underwent tear meniscus height and NIKBUT measurements using the Keratograph^® 5M. Ocular surface parameter assessments such as the fluorescein tear break-up time, ocular surface staining, Schirmer's test, and lid margin and meibomian gland examinations were performed, and the ocular surface disease index was determined. These parameters, including the proportion of the first tear film break-up location and simultaneous multiple tear film break-up pattern, were compared amongst the normal and DED subtypes.

RESULTS

Aqueous-deficient dry eye disease (ADDE) and ADDE/meibomian gland dysfunction (MGD) subtypes showed lower NIKBUTs than those of the normal group, whilst NIKBUTs of the MGD subtype did not differ from those of the normal group. The NIKBUTs showed a good diagnostic ability in diagnosing dry eye except MGD only. The occurrence of the first tear film break-up in the central location was significantly higher in both the ADDE and ADDE/MGD subtypes, comprising approximately 40% in both subtypes (p < 0.001). The proportion of a simultaneous multiple tear film break-up pattern was higher in the ADDE and ADDE/MGD subtypes, at 60.9% and 45.5%, respectively (p < 0.001).

CONCLUSION

The NIKBUTs and the location and pattern of non-invasive tear film break-up were different between normal group and each group of three DED subtypes.

Clinical Efficacy of Pinhole Soft Contact Lenses for the Correction of Presbyopia

We investigated the clinical efficacy of pinhole soft contact lenses for presbyopia correction. Twenty participants with presbyopia wore pinhole soft contact lenses in the non-dominant eye for 2 weeks. Manifest refraction, Goldmann binocular visual field tests, contrast sensitivity tests, and biomicroscopic examinations were performed along with evaluations of questionnaire responses and the binocular corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), distance-corrected intermediate visual acuity (DCIVA), and depth of focus, both before and after 2 weeks of lens wear. DCNVA at 33 and 40 cm and DCIVA at 50 and 70 cm showed significant improvements after pinhole lens wear (P-value: <0.001, <0.001, <0.001, and 0.046, respectively), with no changes in the binocular visual field and binocular CDVA. Contrast sensitivities under photopic and mesopic conditions decreased at some frequencies; however, visual function questionnaire scores significantly improved (all P-values <0.001). These findings suggest that pinhole contact lenses effectively correct presbyopia.

Long-term effects of intense pulsed light treatment on the ocular surface in patients with rosacea-associated meibomian gland dysfunction

PURPOSE

We aimed to determine the long-term effects of intense pulsed light (IPL) treatment in rosacea-associated meibomian gland dysfunction (MGD).

METHODS

We enrolled 17 rosacea subjects with moderate and severe MGD who underwent four IPL sessions at 3-week intervals and were followed up for 12 months. The subjects underwent clinical examinations at baseline (first IPL) and at 3 (second), 6 (third), 9 (fourth), and 12 weeks, as well as 6 and 12 months, after baseline. Ocular surface parameters, including the Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), staining score, and noninvasive Keratograph tear break-up time (NIKBUT), as well as meibomian gland parameters, including the lid margin vascularity and meibum expressibility and quality, were evaluated.

RESULTS

All ocular surface and meibomian gland parameters for all subjects exhibited significant changes from baseline to the final examination (Friedman, P < 0.050 for all). In particular, improvements in the lower lid margin vascularity, meibum expressibility and quality, and ocular symptoms persisted up to the final examination (Wilcoxon, P < 0.050 for all). However, the improvements of TBUT, staining score, and NIKBUT after IPL were not maintained at 6 and 12 months after baseline.

CONCLUSIONS

In rosacea-associated MGD, four IPL treatments at 3-week intervals can improve long-term lid parameters and ocular symptoms without adverse effects.

Long-term Clinical Outcomes of Phototherapeutic Keratectomy in Corneas With Granular Corneal Dystrophy Type 2 Exacerbated After LASIK

PURPOSE

To investigate the long-term clinical outcomes and recurrence patterns of phototherapeutic keratectomy (PTK) in patients with granular corneal dystrophy type 2 (GCD2) exacerbated after LASIK.

METHODS

Fifty-one patients (76 eyes) with GCD2 exacerbated after LASIK who underwent PTK between January 2007 and February 2017 were included. Participants underwent ophthalmic examination, including slit-lamp microscopy, corrected distance visual acuity (CDVA), slit-lamp photography, and Fourier domain optical coherence tomography at preoperative and postoperative visits. PTK was performed using VISX S4 IR (VISX, Inc., Santa Clara, CA). Visual acuity, complications, interval, and contributing factors of recurrence were evaluated.

RESULTS

The follow-up period ranged from 1 to 108 months (mean: 35.22 months). The mean logMAR CDVA was 0.55 ± 0.43 (Snellen equivalent 20/80) preoperatively and 0.09 ± 0.43 (Snellen equivalent 20/25) at 3 months postoperatively. Forty-five (61.6%) eyes developed biomicroscopic recurrence at a mean of 18.6 months after PTK; 20 (27.4%) eyes developed significant recurrence at a mean of 31.3 months after PTK. The flap removal group demonstrated better CDVA at 3 years after surgery and lower recurrence and complication rates than the flap conservation group. Multivariate analysis revealed that flap removal remarkably reduced the risk of both any sign of and significant recurrence.

CONCLUSIONS

PTK improved corneal transparency and visual acuity in patients with GCD2 exacerbated after LASIK, although GCD2 eventually recurred. PTK with flap removal was superior to PTK with flap conservation in terms of visual acuity, recurrence, and complications. [J Refract Surg. 2018;34(2):132-139.].

Assessment of meibomian glands and tear film in post-refractive surgery patients

IMPORTANCE

Corneal refractive surgery may impact meibomian gland and tear film in post-refractive surgery patients.

BACKGROUND

To compare ocular surface parameters between post-refractive surgery patients and normal controls.

DESIGN

Cross-sectional single centre study.

PARTICIPANTS

A total of 120 eyes of 120 subjects were divided into three groups: (i) 60 controls and 60 patients underwent corneal refractive surgery at least 12 months ago; (ii) 30 post-laser in-situ keratomileusis (LASIK) patients and (iii) 30 post-laser epithelial keratomileusis (LASEK)/photo-refractive keratectomy (PRK) patients.

METHODS

Tear meniscus height, non-invasive keratographic tear film break-up time and meibography were measured using the Keratograph^® 5M. Fluorescein break-up time, ocular surface staining, examination of lid margins and meibomian glands, Schirmer's test and Ocular Surface Disease Index questionnaire were performed.

MAIN OUTCOME MEASURES

Ordinary logistic regression was performed to evaluate the impact of clinical variables including refractive surgery on the meiboscores.

RESULTS

In post-LASIK patients, ocular surface parameters including Ocular Surface Disease Index scores, fluorescein break-up time and staining scores, except Schirmer's scores, were significantly worse than those in controls (P < 0.050). Ocular surface staining scores in post-LASEK/PRK patients was higher than that in the controls (P = 0.001). In post-refractive surgery patients, grade of meibomian gland parameters and meiboscores were worse than those of controls (all P < 0.050). Histories of refractive surgery were associated with high meiboscore (β = 1.100, P = 0.043 for LASIK and β = 1.039, P = 0.042 for LASEK/PRK).

CONCLUSIONS AND RELEVANCE

Corneal refractive surgery may adversely affect the ocular surface, and a reduction of functional meibomian glands can contribute to chronic tear film dysfunction after corneal refractive surgery.

Analysis of Factors Associated With the Tear Film Lipid Layer Thickness in Normal Eyes and Patients With Dry Eye Syndrome

PURPOSE

To determine the effects of clinical variables, including age, sex, history of refractive or cataract surgery, contact lens use, and ocular surface and meibomian gland parameters on the lipid layer thickness (LLT) in normal subjects and patients with dry eye syndrome (DES).

METHODS

A total of 64 normal subjects and 326 patients with DES were enrolled, and they underwent measurements of LLT with a LipiView interferometer and tear meniscus height using optical coherence tomography, tear film break-up time (TBUT) determination, ocular surface staining, Schirmer's test, examination of the lid margins and meibomian glands, and assessment using the Ocular Surface Disease Index (OSDI).

RESULTS

In normal subjects, the median (range) LLT was 67 (33-100) nm, and age was the only factor that was significantly associated with LLT (β = 0.678, P = 0.028). In patients with DES, the median (range) LLT was 84 (20-100) nm, and 79.0% of the participants fulfilled the diagnostic criteria for meibomian gland dysfunction (MGD). In a multivariate analysis, increased age and female sex were significantly related to increased LLT (β = 0.282, P = 0.005 and β = 11.493, P < 0.001), and hypersecretory MGD and lid margin inflammation were independently associated with increased LLT (β = 11.299, P = 0.001 and β = 12.747, P = 0.001).

CONCLUSIONS

Lipid layer thickness measurements using a new interferometer are significantly affected by demographic factors such as age, sex, ocular surgical history, and MGD type. Therefore, all of these factors must be considered in the diagnosis of ocular surface diseases.

Meibomian gland dysfunction and tear cytokines after cataract surgery according to preoperative meibomian gland status

BACKGROUND

To investigate the possible mechanisms by which cataract surgery aggravates meibomian gland dysfunction (MGD), we evaluated the changes in tear cytokines and ocular surface parameters after cataract surgery according to the preoperative MGD grade.

DESIGN

Prospective, observational case series.

PARTICIPANTS

A total of 50 eyes from 50 patients who underwent cataract surgery were included.

METHODS

Patients were classified into two groups: Group I had no or minimal MGD, and group II had grades 2-4 MGD. Ocular surface parameters were measured, including tear film break-up time, Schirmer I test, ocular surface staining and Ocular Surface Disease Index, and tear cytokine levels were measured.

MAIN OUTCOME MEASURES

The main outcomes were changes in ocular surface parameters and inflammatory tear cytokine concentrations.

RESULTS

In group II, preoperative MGD grade, ocular surface staining, tear film break-up time and Ocular Surface Disease Index were worse, and mean interleukin (IL)-2, IL-6 and TNF-α levels were higher than those of group I. MGD and ocular surface parameters were worsened to a greater degree after surgery in group II than in group I (P < 0.050). In group II, IL-6 and TNF-α levels significantly increased at postoperative 1 month, and there were significant correlations between changes in ocular surface parameters and tear cytokines (IL-2, IL-6 and TNF-α; P < 0.050).

CONCLUSIONS

The extent to which the MGD grade was aggravated following cataract surgery differed based on preoperative MGD grade. Preoperative MGD and ocular surface status should be carefully evaluated.

Tectonic Lamellar Keratoplasty Using Cryopreserved Cornea in a Large Descemetocele

We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80°C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.

Herbacetin Is a Novel Allosteric Inhibitor of Ornithine Decarboxylase with Antitumor Activity

Ornithine decarboxylase (ODC) is a rate-limiting enzyme in the first step of polyamine biosynthesis that is associated with cell growth and tumor formation. Existing catalytic inhibitors of ODC have lacked efficacy in clinical testing or displayed unacceptable toxicity. In this study, we report the identification of an effective and nontoxic allosteric inhibitor of ODC. Using computer docking simulation and an in vitro ODC enzyme assay, we identified herbacetin, a natural compound found in flax and other plants, as a novel ODC inhibitor. Mechanistic investigations defined aspartate 44 in ODC as critical for binding. Herbacetin exhibited potent anticancer activity in colon cancer cell lines expressing high levels of ODC. Intraperitoneal or oral administration of herbacetin effectively suppressed HCT116 xenograft tumor growth and also reduced the number and size of polyps in a mouse model of APC-driven colon cancer (ApcMin/+). Unlike the well-established ODC inhibitor DFMO, herbacetin treatment was not associated with hearing loss. Taken together, our findings defined the natural product herbacetin as an allosteric inhibitor of ODC with chemopreventive and antitumor activity in preclinical models of colon cancer, prompting its further investigation in clinical trials.

The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery

PURPOSE

To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery.

MATERIALS AND METHODS

A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation.

RESULTS

Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30±4.25, 4.87±6.03, and 12.47±12.24 μm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant.

CONCLUSION

Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.

Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers

PURPOSE

To compare clinical outcomes after implantation of TECNIS diffractive multifocal intraocular lenses (IOLs) with different add powers.

DESIGN

Prospective, comparative, interventional case series.

METHODS

Subjects underwent cataract extraction and diffractive multifocal IOL implant. Subjects had an additional add power of +2.75 diopters (D) (Group 1, 23 eyes), +3.25 D (Group 2, 21 eyes), or +4.00 D (Group 3, 21 eyes). Evaluations were performed 1 and 3 months following cataract surgery, including measurement of monocular uncorrected distance visual acuity (UDVA), refractive error (manifest refraction [MR]), and monocular uncorrected near visual acuity (UNVA) at 33, 40, and 50 cm. At 3 months, internal aberrations and contrast sensitivity were evaluated and subjects completed a questionnaire on outcomes satisfaction, visual symptoms, and spectacle use.

RESULTS

Sixty-five eyes (43 subjects) were included. After surgery, no significant differences between groups were observed in UDVA and MR values. UNVA at 33 cm was best in Group 3 (1 month: P = .032; 3 months: P = .031). Three months after surgery, UNVA was best in Group 1 at 50 cm (P = .017). No significant differences in internal aberration and contrast sensitivity were observed between groups and surgical satisfaction was worst in Group 3 (P = .001). A total of 87.0%, 85.7%, and 76.9% had spectacle independence in Groups 1, 2, and 3, respectively (P = .080).

CONCLUSIONS

TECNIS diffractive multifocal IOLs with lower add powers provide good vision over longer working distances and excellent distant vision. Subjects with lower add power had greater satisfaction, more spectacle independence, and fewer visual symptoms than those with +4.00 D add.

Effect of the pigment-free optical zone diameter of decorative tinted soft contact lenses on visual function

AIMS

We investigated changes in visual function after wearing decorative tinted soft contact lenses with different pigment-free optical zone diameters.

METHODS

A prospective study was performed in 30 eyes of 30 healthy volunteers. Best-corrected visual acuity (BCVA), ocular higher-order aberrations (HOAs), modulation transfer function (MTF), Strehl ratio and contrast sensitivity were evaluated after wearing clear lens and tinted lenses with different pigment-free optical zone diameters (4, 5 and 6 mm).

RESULTS

BCVA decreased from 0.00 logMAR after wearing a clear lens to 0.04±0.04 logMAR after wearing 4 mm optical zone lens (p<0.001). As the optical zone diameter decreased, ocular aberrations were induced. Total HOAs, coma aberration and secondary astigmatism showed significant difference between clear lens and 5 or 4 mm optical zone lenses (p<0.050). Spherical aberration and trefoil showed significant difference between clear lens and 4 mm optical zone lens (p<0.050). The results for Strehl ratio revealed poorer optical quality for both 5 and 4 mm optical zone lens (both p=0.002). The entire ocular MTF was significantly different, corresponding to the decreased optical zone diameter. The HOAs showed a correlation with the blocked pupil covered by the tinted part (r=0.435, p<0.001). In photopic and mesopic conditions, the contrast sensitivity decreased significantly with the reduced pigment-free optical zone diameters.

CONCLUSION

Decorative tinted contact lenses significantly increased ocular aberrations and decreased optical quality and contrast sensitivity, as the pigment-free optical zone diameter decreased. Therefore, consumers of tinted lenses should be informed about the possible disturbance in visual function.

TRIAL REGISTRATION NUMBER

NCT02537275.

Tear Cytokines as Biomarkers for Chronic Graft-versus-Host Disease

We investigated the tear cytokine profiles in patients who underwent stem cell transplantation (SCT) and attempted to evaluate whether tear cytokines are associated with the presence of systemic chronic graft-versus-host disease (GVHD), regardless of ocular GVHD status. We also tested tear cytokines as biomarkers for chronic ocular GVHD severity. Forty-four patients who underwent SCT were enrolled and their diagnosis of chronic GVHD was confirmed. Ocular surface parameters and tear cytokine profiles were evaluated and the correlations between concentrations of cytokines and ocular surface parameters or several chronic ocular GVHD severity scales were evaluated. Tear interleukin (IL)-2, IL-10, IL-17α, interferon (IFN)-γ, IL-6, and tumor necrosis factor (TNF)-α were elevated in patients with chronic systemic GVHD compared with patients without chronic systemic GVHD. Receiver-operating characteristic curve analysis revealed that area under the curve (AUC) values for tear IL-10 (AUC = .795), IL-17α (AUC = .821), IL-6 (AUC = .912), and TNF-α (AUC = .910) were significantly correlated with the presence of chronic GVHD (all P < .001). Tear IL-10, IL-6, and TNF-α showed a stronger correlation with ocular surface parameters than other cytokines and these cytokines also correlated with several chronic ocular GVHD severity scales (all P < .05). Our data suggest the tear cytokines are useful biomarkers for the diagnosis of chronic GVHD after SCT and chronic ocular GVHD severity.

Comparison of Measurements and Clinical Outcomes After Wavefront-Guided LASEK Between iDesign and WaveScan

PURPOSE

To compare the measurements of refractive errors and ocular aberrations obtained using iDesign and WaveScan (Abbott Medical Optics, Inc., Santa Ana, CA), and to compare surgical outcomes of wavefront-guided LASEK using ablation profiles based on both aberrometers.

METHODS

Ninety myopic eyes of 45 normal patients were evaluated using both the iDesign and WaveScan to measure spherical and cylindrical errors, spherical equivalents, and Zernike coefficients of ocular aberrations. Wavefront-guided LASEK was performed in a different group of 59 eyes of 30 patients divided into two groups, the iDesign and Wavescan groups. The clinical outcomes between the two groups including uncorrected visual acuity, refractive errors, contrast sensitivity, and ocular aberration were compared at 1, 3, and 6 months postoperatively.

RESULTS

The iDesign produced significantly higher myopic values for refractive errors than the WaveScan, as well as significantly lower levels of total higher order, third, fourth, and fifth order root mean square values and Zernike coefficients of vertical coma and spherical aberration. At postoperative 1, 3, and 6 months, there were no statistically significant differences between the two groups in terms of uncorrected visual acuity and remaining refractive errors. The percentages of patients with spherical equivalents within ±1.00 and ±0.50 diopters of emmetropia were 100% (29 eyes) and 75.9% (22 eyes), respectively, in the iDesign group and 96.7% (29 eyes) and 70.0% (21 eyes), respectively, in the WaveScan group. Mesopic contrast sensitivity values were significantly higher, and the change in root mean square values for spherical aberration was significantly lower in the iDesign group.

CONCLUSIONS

There were significant differences between the iDesign and the WaveScan in the measurements of refraction and ocular aberrations. Wavefront-guided LASEK based on an ablation profile from the iDesign demonstrated comparable refractive predictability with the WaveScan group, resulting in minimal physician adjustment and superior postoperative visual quality.

Lattice corneal dystrophy type IIIA with hyaline component from a novel A620P mutation and distinct surgical treatments

PURPOSE

The aim of this study was to report a lattice corneal dystrophy (LCD) family with a novel mutation of A620P in the TGFBI gene, its long-term treatment, follow-up data, and related pathologic findings.

METHODS

A total of 28 family members were clinically examined, and blood samples or buccal epithelial cells were taken for DNA analysis. All exons from the entire TGFBI gene coding region were analyzed for mutations in 3 affected members. Exon 14 was amplified in other family members and in 100 normal Korean persons as control. Corneal tissues from 1 affected family member were examined using light and electron microscopy.

RESULTS

Clinical examination revealed relatively late-onset LCD with asymmetric progression and recurrent corneal erosion. The affected family members have been treated with penetrating keratoplasty, deep lamellar keratoplasty, and phototherapeutic keratectomy for up to 19 years. Screening of the TGFBI gene revealed a novel A620P mutation, which was found in all affected members. The amyloid origin of deposits was confirmed by Congo red and was also partially stained with Masson trichrome. Although there were no electron-dense bodies as in granular dystrophy, transmission electron microscopy demonstrated that the stromal deposits were not homogenous and contained a variety of constituents with different electron densities.

CONCLUSIONS

We present the characteristics and surgical treatment of corneas with a novel A620P mutation in TGFBI showing LCD type IIIA with hyaline component.

Long-term result of maintenance treatment with tacrolimus ointment in chronic ocular graft-versus-host disease

PURPOSE

To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft-vs-host disease (GVHD) with ocular surface inflammation.

DESIGN

A retrospective interventional consecutive case series.

METHOD

Long-term maintenance treatment (≥6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations.

RESULTS

Thirteen patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 (P = .001) within 2-8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects.

CONCLUSION

Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD.